Individual

The individual checklist is used to determine which items are needed for a clean application based on the provider's specialty type. The shaded areas indicate which items are required. Note: Mid-level includes nurse practitioners, physician assistants, certified registered nurse anesthetists, certified nurse midwives, clinical nurse specialists and hospital-based physicians. Ancillary includes speech, physical, occupational and audiology therapists.

Group Practice

The group practice checklist is used to determine which items are needed for a clean application based on the provider's group type. The shaded areas indicate what is required.

In-State, Out-of-Network

The in-state, out-of-network checklist is for providers that are in South Carolina, but want to remain out-of-network. It is used to determine which items are needed for a clean application based on their enrollment type. The shaded areas indicate what is required.

Electronic Signatures vs. Wet Signatures

These charts determine whether an application or form can be signed electronically.

Medical

Behavioral Health